What are the Chances?

You’re caught in a thunderstorm. Apart from getting wet, thunder is rolling around above you and there is some spectacular lightning. The inevitable thought crosses your mind. What are the chances of me being struck by that lightning? You are probably thinking that the chances are pretty slim when in fact, assuming you live for 80 years the chances are 1 in 15300. I bet that’s higher than you thought so take care next time you are caught in that thunderstorm.

The Pre-Surgical Jitters: Navigating the Fear of the Unknown

You have to go into hospital for a routine operation. Prior to the operation, the surgeon visits you to explain the procedure to you and the benefits and risks. You have to sign an informed consent form giving the surgeon permission to perform the operation. Now you’re waiting to be taken to theatre. Your thoughts turn to the operation and the consent form you signed. The benefits of the operation were pretty clear, but there was a long list of risks attached and some of them could cause death. Inevitably the thought crosses your mind that you might not make it through the operation. Your imagination goes int overdrive. What if….. Slight panic sets in.

Deciphering Surgical Risks: Complexity and Outcomes

The risk of death from surgery is a topic that many people are concerned about, especially if they are facing a major operation. However, the chances of dying from surgery depend on several factors, such as the type of surgery, the patient's health history, and the quality of anaesthesia. In this blog post, we will explore some of these factors.

One of the most important factors that affect the risk of death from surgery is the type of surgery being performed. Some surgeries are more complex and invasive than others and require more skill and experience from the surgeon and the anaesthetist. For example, open heart surgery, where the heart is stopped and restarted, has a higher risk than carpal tunnel surgery, which is performed on the hand and wrist. According to a study by the Canadian Medical Association Journal(1), the risk of death for non-cardiac inpatient surgeries of individuals 45 and over was 1.8%. In another study published in 2018 in the journal Anaesthesia(2) the mortality rate of heart failure patients undergoing surgery was 8%.

Another factor that influences the risk of death from surgery is the patient's health history, which includes their age, weight, chronic diseases, infections, smoking status, drug or alcohol abuse, and family history. These factors can affect how well the patient tolerates the surgery and anaesthesia, and how quickly they recover from the procedure. For example, older patients are more likely to have complications from surgery than younger patients, because they have weaker immune systems and more co-existing medical conditions. According to a study published in JAMA Surgery(3) in 2022, the one-year mortality rate among older adults who have major surgery was 13.4% and was 3-fold higher for nonelective than elective procedures. 

Emergency Situations: When Time is of the Essence

Some surgeries also have a higher mortality rate because they are done in emergency situations, where the patient's condition is unstable or life-threatening. For example, surgery for an aortic dissection, which is a tear in the wall of the main artery that carries blood from the heart, has a 22.1% in-hospital mortality rate(4). Another example is cranial decompression surgery, which is done to relieve pressure on the brain caused by bleeding or swelling, which has a 26.4% mortality rate(5).

Patient Health History: The Underlying Factors Affecting Surgical Outcomes

Some health conditions also increase the risk of death from surgery because they affect the function of vital organs or systems. For example, diabetes can impair wound healing and increase the risk of infection; breathing problems can affect oxygen delivery and ventilation; blood clotting disorders can cause bleeding or stroke; and heart problems can cause arrhythmias or heart failure. Additionally, some health conditions can increase the risk of having an adverse reaction to anaesthesia, such as malignant hyperthermia, which is a genetic disorder that causes a very high fever and muscle rigidity when exposed to certain anaesthetic drugs.

The Role of Anaesthesia: Types, Benefits, and Risks

Anaesthesia can be general, where the patient is completely unaware of what is happening; regional, where only a part of the body is numbed; or local, where only a small area is numbed. Anaesthesia can also be combined with sedation, where the patient is relaxed but still awake.

Anaesthesia is generally safe and effective, but it also carries some risks. The most common complications from anaesthesia are nausea, vomiting, sore throat, headache, and drowsiness. However, in rare cases, anaesthesia can cause serious problems such as allergic reactions, nerve damage, brain damage, or death. According to the American Society of Anaesthesiologists,

the overall risk of dying from anaesthesia is 1 in 185,000 . However, this risk can vary depending on the type and duration of anaesthesia, the type and complexity of surgery, the skill and experience of the anaesthetist, and the patient's health history.

Conclusion: Making Informed Decisions in the Face of Uncertainty

The risk of death from surgery is not something that can be easily predicted or prevented. However, by knowing some of the factors that affect this risk, and by discussing them with your surgeon and anaesthetist you can make informed decisions about your surgical options and prepare yourself for the possible outcomes. Remember that most surgeries are safe and successful, and that your surgical team will do their best to ensure your safety and comfort. When it comes to developing new products, Innovgas puts the safety and comfort of the patient as its number one priority. Our products EyePro, NoPress and BiteMe just do that.

References

1. Association between complications and death within 30 days after noncardiac surgery. The Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators. CMAJ 2019 July 29;191:E830-7. doi: 10.1503/cmaj.190221

2. Sellers, D., Srinivas, C. and Djaiani, G. (2018), Cardiovascular complications after non-cardiac surgery. Anaesthesia, 73: 34-42. https://doi.org/10.1111/anae.14138

3. Gill TM, Vander Wyk B, Leo-Summers L, Murphy TE, Becher RD. Population-Based Estimates of 1-Year Mortality After Major Surgery Among Community-Living Older US Adults. JAMA Surg. 2022;157(12):e225155. doi:10.1001/jamasurg.2022.5155

4. Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, Evangelista A, Fattori R, Suzuki T, Oh JK, Moore AG, Malouf JF, Pape LA, Gaca C, Sechtem U, Lenferink S, Deutsch HJ, Diedrichs H, Marcos y Robles J, Llovet A, Gilon D, Das SK, Armstrong WF, Deeb GM, Eagle KA. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 2000 Feb 16;283(7):897-903. doi: 10.1001/jama.283.7.897. PMID: 10685714.

5. Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension P.J. Hutchinson, A.G. Kolias, I.S. Timofeev, E.A. Corteen, M. Czosnyka, J. Timothy, I. Anderson, D.O. Bulters, A. Belli, C.A. Eynon, J. Wadley, A.D. Mendelow, P.M. Mitchell, M.H. Wilson, G. Critchley, J. Sahuquillo, A. Unterberg, F. Servadei, G.M. Teasdale, J.D. Pickard, D.K. Menon, G.D. Murray, and P.J. Kirkpatrick, for the RESCUEicp Trial Collaborators. N Engl J Med 2016;375:1119-30. DOI: 10.1056/NEJMoa1605215.

Author: Niall Shannon, European Business Manager, Innovgas

This article is based on research and opinion available in the public domain.

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